The amount of medical care that people get for serious illnesses varies enormously from place to place. In the last two years of life, the average patient spent 11 days in the hospital in Bend, Ore., and 35 days in Manhattan. In those same two years, patients visited the doctor an average of 34 times in Ogden, Utah, and 109 times in Los Angeles.
The Dartmouth Atlas based those findings on the Medicare claims records of millions of patients who died from (in order of prevalence) congestive heart failure, chronic pulmonary (lung) disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular (circulatory) disease, diabetes with organ damage, and severe chronic liver disease. Together those ailments account for about 90 percent of deaths of people older than 65.
Over the years, Dartmouth research has yielded some startling insights:
- The local supply of doctors and hospitals has more influence on the amount and type of care that patients receive than their actual medical conditions have. The more medical resources a region has, the more aggressive the treatments are.
- In the regions that deliver the most care, patients have a slightly higher death rate than patients with the same conditions treated in areas that treat less aggressively.
- Patients treated most aggressively are no more satisfied with their care.
- The cost differences are vast. Average Medicare spending over the last two years of life for all hospitals ranged from a high $181,143 in Manhattan to a low of $29,116 in Dubuque, Iowa.
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A recent case study by doctors at Mount Sinai Hospital in New York examined the ethical issues posed by transplant tourism, an offshoot of medical tourism, which focuses solely on transplantation surgery.
Many American transplant professionals frown on the practice of transplant tourism where patients travel to countries such as China, India, and the Philippines for their transplantation.
These transplant tourists may be subject to sub-standard surgical techniques, poor organ matching, unhealthy donors, and post transplant infections, prompting U.S. health care institutions to refuse treatment of these patients upon return to the U.S. Medical associations have responded with transplant tourism policies and guidelines to advise clinicians on the ethics of caring for transplant tourists.
Full details of the study appear in the February issue of Liver Transplantation, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases (AASLD). Some might think of transplant or medical tourism as merely a fictional plot from one of Robin Cook’s medical thriller books (Foreign Body).
However, given the critical shortage of available organs in the U.S., transplant tourism has grown in popularity among patients awaiting transplantation. Currently, the United Network of Organ Sharing (UNOS) reports there are more than 105,000 Americans on the transplant candidate waiting list with more than 15,000 patients awaiting a liver transplant. Furthermore, UNOS data shows a decline in donorship with living donor numbers decreasing by 1.7% and deceased donors down by 1.2% in 2008.
In the current case, a 46-year-old Chinese accountant (HQ) was placed on the UNOS transplant registry with a Model for End Stage Liver Disease (MELD) score of 18 that increased to 21 while on the candidate waitlist for over a year (MELD scores range from 6 for those least ill through 40 for those most sick).
HQ then traveled to the People’s Republic of China (PRC) and was transplanted two weeks after arrival. After transplantation, HQ returned to the Mount Sinai program requesting follow-up care, which was provided. HQ then developed biliary sepsis requiring hospitalization and re-transplantation seemed to be the only viable option.
“While the patient was a medically suitable candidate, team members disagreed if it were indeed, morally right to provide him with a transplant,” said Thomas Schiano, M.D., one of the case clinicians and lead author of this study.
Ultimately, the transplant team proceeded with a liver transplant for HQ and he is currently doing well. “Our consensus to transplant was based on the relevant principles of medical ethics—non-judgmental regard, beneficence, and fiduciary responsibility,” added Dr. Schiano.
The study authors estimate that more than 400 patients received transplants abroad with 75% of those taking place between 2004 and 2006.
Of those transplant tourists, 40% reside in New York and California, and the majority these patients traveled to the PRC, where organs from executed prisoners have been used in transplantations.
Although transplant tourism is not held in high regard, the practice violates neither current U.S. law nor the National Organ Transplant Act. Current UNOS policies allow a small percentage of each center’s transplants to be allotted for foreign nationals, essentially allowing for transplant tourism within the U.S.
Over the last few years, professional associations have established transplant tourism policies to provide guidance to clinicians and uphold the principles of medical ethics.
The AASLD and International Liver Transplant Society (ILTS) have positions against the exploitation of donors, the recovery of organs from executed prisoners, and condemned the use of paid living donors. Similarly, the American Society of Transplantation declares that optimal medical care should not be withheld from those recipients who have chosen to receive transplants as “tourists” from abroad.
“Unfortunately, little guidance from societal statements are provided to transplant centers and the professionals in the trenches dealing with transplant tourists seeking care,” Dr. Schiano stated. Given the shortage of available organs, more patients may resort to transplant tourism as an option.
“Although we do not condone all of the practices associated with transplant tourism, it is our duty to provide all transplant patients with the same compassionate care and support, whether their transplantation was performed in the U.S. or abroad,” concluded Dr. Schiano.
To build awareness of the need for organ donors, February 14, 2010 is designated as National Donor Day in the U.S. The Department of Health and Human Services provides further information on National Donor Day.
Source: Wiley-Blackwell – esciencenews.com
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Despite the ongoing downturn faced by the tourism industry around the world, tourism industry in Turkey has reported significant growth rate in recent time. International tourists arrivals has increased by 2.7% in 2009 over 2008 as compare to negative growth faced by world tourism industry.
With strong government efforts and increasing popularity of Turkey as a tourism destination, the international tourist arrivals in Turkey is expected to increase at a health rate of over 10% in coming four years, with outbound and domestic tourism is also expected see the high growth rates.
Medical tourism is expected to see a maximum growth in coming years. Medical tourists are expected to increase by over 20% in coming years. Increasing healthcare costs in European countries and developing healthcare infrastructure in Turkey will drive the growth of medical tourism in Turkey. A part from that marine tourism and golf tourism is also expected to see a huge growth in coming years.
Turkey tourism industry by 2013 report provides an insight into the Turkish tourism market. It evaluates the past, present and future scenario of the Turkish tourism market and discusses the key factors which are making Turkey a potential tourism destination. Report deeply analysed the different parameters of tourism industry, including inbound tourism, domestic tourism, outbound tourism, medical tourism, hotel industry etc.
Report provides the future forecast till 2013 for the major tourism indicators. Report also covers the major players in the tourism industry including major hotel chains and airlines.
“Medical Tourism to Drive Tourism Industry in Turkey
As per recently released report “Turkey Tourism Industry by 2013?, despite the ongoing downturn faced by the tourism industry around the world, tourism industry in Turkey has reported significant growth rate in recent time. International tourists arrivals has increased by 2.7% in 2009 over 2008 as compare to negative growth faced by world tourism industry.
With strong government efforts and increasing popularity of Turkey as a tourism destination, the international tourist arrivals in Turkey is expected to increase at a health rate of over 10% in coming four years, with outbound and domestic tourism is also expected see the high growth rates.
Medical tourism is expected to see a maximum growth in coming years. Medical tourists are expected to increase by over 20% in coming years. Increasing healthcare costs in European countries and developing healthcare infrastructure in Turkey will drive the growth of medical tourism in Turkey. A part from that marine tourism and golf tourism is also expected to see a huge growth in coming years.
Turkey tourism industry by 2013 report provides an insight into the Turkish tourism market. It evaluates the past, present and future scenario of the Turkish tourism market and discusses the key factors which are making Turkey a potential tourism destination. Report deeply analysed the different parameters of tourism industry, including inbound tourism, domestic tourism, outbound tourism, medical tourism, hotel industry etc.
Report provides the future forecast till 2013 for the major tourism indicators. Report also covers the major players in the tourism industry including major hotel chains and airlines.”
Source: Earthtimes.org
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